• Bo-Gun Suh, Myun-Whan Ahn, Ho-Joong Kim, Jin S Yeom, and Gun Woo Lee.
• *Spine Center and Department of Orthopaedic Surgery, Pohang Semyeng Christianty Hospital, Pohang, Korea; †Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, Korea; ‡Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea.
• Spine. 2016 May 11.

Study DesignProspective randomized double-arm non-inferiority study OBJECTIVE.: To evaluate an additional surgical procedure (wedge-shaped resection of the cranial portion of the posterior bony arch) during open-door laminoplasty (ODLP), and to compare the outcomes with those of conventional ODLP surgery SUMMARY OF BACKGROUND DATA.: In clinical practice, spine surgeons sometimes encounter patients who show bony impingement on lateral radiographs after ODLP; bony impingement may lead to reduced motion of the cervical spine and posterior neck pain. However, this problem has not been well studied, and no methods have been developed to prevent it.MethodsOf total 79 patients, 75 were enrolled and randomly assigned to either group A (additional procedure in ODLP, n = 38) or group B (ODLP alone, n = 37). The primary outcome measure was range of motion (ROM) of the cervical spine. Secondary endpoints included clinical outcomes based on pain intensity, 12-item short form health survey (SF-12) and modified Japanese Orthopedic Association (mJOA) scale; presence of bony impingement on dynamic lateral radiographs; surgical outcomes; and surgery-related complications.ResultsROM of the cervical spine was significantly greater at six months (P = 0.04) and one year (P = 0.02) postoperative in group A than in group B. Pain intensity at the posterior neck was significantly lower one year after surgery in group A than in group B (P = 0.03). In lateral radiographs one year after surgery, the presence of posterior bony impingement was 0% in group A and 32.4% in group B (P < 0.01). Clinical outcomes and surgery-related complications were similar between groups.ConclusionPerforming wedge-shaped resection of the cranial portion of the posterior bony arch in ODLP surgery can lead to better outcomes than ODLP alone in terms of preservation of cervical ROM, prevention of posterior bony impingement, and amelioration of posterior neck pain.Level Of Evidence2.

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